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Romano I, Butler A, Williams G, Aleyan S, Patte KA, Leatherdale ST. Risky cannabis use is associated with varying modes of cannabis consumption: Gender differences among Canadian high school students. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100101. [PMID: 36844170 PMCID: PMC9948853 DOI: 10.1016/j.dadr.2022.100101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Our objective was to explore associations between indicators of more risky cannabis use (i.e., solitary use, frequent use, and younger age of initiation) and different modes of cannabis use (i.e., smoking, vaping and/or edibles). METHODS Data were gathered from a large sample of Canadian youth in Alberta, British Columbia, Ontario, and Quebec who participated in Year 8 (2019-20) of the COMPASS study, and who reported using cannabis in the past year (n = 4,763). Generalized estimating equations were used to examine associations between risky cannabis use and modes of cannabis use, stratified by gender. RESULTS Overall, 38% of students reported using multiple modes of cannabis use. Consistent among both males and females, students who used cannabis alone (35%) and at a higher frequency (55%) were more likely to use multiple modes than smoking only. Among females, those who used cannabis alone were more likely to report using edibles only compared to smoking only (aOR=2.27, 95%CI=1.29-3.98). Earlier cannabis use initiation was associated with lower likelihood of vaping cannabis only among males (aOR=0.25; 95%CI = 0.12-0.51), and lower likelihood of using edibles only among females (aOR=0.35; 95%CI = 0.13-0.95), than by smoking only. CONCLUSIONS Our findings suggest that multiple modes of use may be an important indicator or risky cannabis use among youth, given associations with frequency, solitary use, and age of onset.
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Affiliation(s)
- Isabella Romano
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Alexandra Butler
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Gillian Williams
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sarah Aleyan
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Karen A. Patte
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada
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Tourism Network Attention Variation of Chinese Cities under the COVID-19 Pandemic. SUSTAINABILITY 2022. [DOI: 10.3390/su14095131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
At the end of 2019, the COVID-19 pandemic broke out globally and had a tremendous impact on tourism development in countries around the world. The rapid shift of tourism from “over-tourism” to “under-tourism”, threatening the future of the global economy and society, has generated considerable interest from academia and the policy community, but the impact of COVID-19 on tourism variation remains untested by empirical evidence. Based on the daily Baidu Index of 247 prefecture-level cities in China from 2018 to 2021, this study assessed the treatment effect of COVID-19 on tourism and analyzed its dynamic characteristics using the regression-discontinuity-design (RDD) method combined with tourism network attention (TNA) data. The results show that after the outbreak of the COVID-19 pandemic, the level value of TNA dropped significantly by 2.12 (p < 0.10), and the difference value of TNA (TNA_diff) dropped significantly by 10.77 (p < 0.01), indicating that COVID-19 has a negative causal effect on tourism development, and its impact is more pronounced in major tourist source cities, with a coefficient of −14.91 (p < 0.01) corresponding to −4.57 (p < 0.01) for non-major tourist source cities when the dependent variable TNA_diff. The identification of dynamic effects further confirms that the negative impact of the pandemic on tourism network attention is fluctuating and persistent during the study period, with the two major “golden weeks” and peak season being the most severe. Compared to 2020, the TNA has generally shown an upward trend since 2021, indicating signs of a rebound in the vitality of resident tourism, which is conducive to the healthy development of the tourism market.
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Wang GS, Buttorff C, Wilks A, Schwam D, Tung G, Banerji S, Dart RC, Pacula RL. Comparison of hospital claims and poison center data to evaluate health impact of opioids, cannabis and synthetic cannabinoids. Am J Emerg Med 2022; 53:150-153. [PMID: 35051702 PMCID: PMC8956045 DOI: 10.1016/j.ajem.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Over the past 10 years, opioids and cannabis have garnered significant attention due to misuse and legalization trends. Different datasets and surveillance mechanisms can lead to different conclusions the due to a variety of factors. The primary objective of this study was to compare and describe trends of opioid, cannabis, and synthetic cannabinoid-related healthcare encounters and poison center (PC) cases in Colorado, a state that has legalized cannabis. METHODS This was a retrospective study comparing hospital claims data (Colorado Hospital Association (CHA)) and poison center cases to describe opioid, cannabis and synthetic cannabinoid-related healthcare encounters and exposures in Colorado from 2013 to 2017 using related genetic codes and International Statistical Classification of Disease codes. RESULTS Both datasets observed increases in cannabis related encounters and exposures after recreational cannabis legalization in 2014. CHA reported an increase for cannabis-related ER visits from 14,109 in 2013 to 18,118 in 2017 while PC noted a 74.4% increase in cannabis-related cases (125 to 218). CHA inpatient visits associated with cannabis also increased (8311 in 2013 to 14,659 in 2017). On the other hand, Opioid-related exposures to the PC fell (1092 in 2013 to 971 in 2017) while both Opioid-related ER visits (8580 in 2013 to 12,928 in 2017) and inpatient visits in CHA increased (9084 in 2013 to 13,205). CONCLUSIONS This study demonstrates the differences in surveillance methodology for concurrent drug abuse epidemics using hospital claims and PC data. Both systems provide incomplete reports, but in combination can provide a more complete picture.
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Affiliation(s)
- George Sam Wang
- University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Department of Pediatrics, 13123 East 16th Ave B251, Aurora, CO 80045, United States of America.
| | | | - Asa Wilks
- RAND Corporation, United States of America.
| | | | - Greg Tung
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Department of Health Systems, Management & Policy
| | - Shireen Banerji
- Rocky Mountain Poison and Drug Safety, Denver Health Hospital AuthorityShireen, United States of America.
| | - Richard C Dart
- Rocky Mountain Poison and Drug Safety, Denver Health Hospital Authority
| | - Rosalie Liccardo Pacula
- University of Southern California, Sol Price School of Public Policy, Schaeffer Center for Health Policy & Economics, United States of America.
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Schlienz NJ, Scalsky R, Martin EL, Jackson H, Munson J, Strickland JC, Bonn-Miller MO, Loflin M, Vandrey R. A Cross-Sectional and Prospective Comparison of Medicinal Cannabis Users and Controls on Self-Reported Health. Cannabis Cannabinoid Res 2021; 6:548-558. [PMID: 33998852 PMCID: PMC8713273 DOI: 10.1089/can.2019.0096] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction: Despite widespread legalization, the impact of medicinal cannabis use on patient-level health and quality of life (QOL) has not been carefully evaluated. The objective of this study was to characterize self-reported demographics, health characteristics, QOL, and health care utilization of Cannabis Users compared with Controls. Methods: A longitudinal, cross-sectional web-based survey study was completed between April 2016 and February 2018. Study participants (n=1276) were a convenience sample of either patients with a diagnosed health condition or caregivers of a patient with a diagnosed health condition registered with the Realm of Caring Foundation (a nonprofit organization dedicated to therapeutic cannabis research and education). Participants were invited through e-mail to complete follow-up assessments every 3 months with 33% of participants completing one or more prospective follow-ups. Assessments included self-reported demographics, health care utilization, medication use, pain, anxiety, depression, sleep, and QOL. Cannabis Users (n=808) were compared with Controls (n=468) using negative binomial regression and linear mixed effects models testing the effect of initiation, cessation, and maintenance of medicinal cannabis use. Results: Cannabis Users self-reported significantly better QOL [t(1054)=-4.19, p<0.001], greater health satisfaction [t(1045)=-4.14, p<0.001], improved sleep [children: t(224)=2.90, p<0.01; adults: [t(758)=3.03, p<0.01], lower average pain severity [t(1150)=2.34, p<0.05], lower anxiety [t(1151)=4.38, p<0.001], and lower depression [t(1210)=5.77, p<0.001] compared with Controls. Cannabis Users reported using fewer prescription medications (rate ratio [RR]=0.86; 95% confidence interval [CI]: 0.77-0.96) and were less likely to have a past-month emergency department visit (RR=0.61; 95% CI: 0.44-0.84) or hospital admission (RR=0.54; 95% CI: 0.34-0.87). Controls who initiated cannabis use after baseline showed significant health improvements at follow-up, and the magnitude of improvement mirrored the between-group differences observed at baseline. Conclusions: Cannabis use was associated with improved health and QOL. Longitudinal testing suggests that group differences may be due to the medicinal use of cannabis. Although bias related to preexisting beliefs regarding the health benefits of cannabis in this sample should be considered, these findings indicate that clinical trials evaluating the efficacy of defined cannabinoid products for specific health conditions are warranted.
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Affiliation(s)
- Nicolas J. Schlienz
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
| | - Ryan Scalsky
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Erin L. Martin
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Joel Munson
- Realm of Caring Foundation, Colorado Springs, Colorado, USA
| | - Justin C. Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marcel O. Bonn-Miller
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mallory Loflin
- Center of Excellence for Stress and Mental Health, VA San Diego Health care System, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, California, USA
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Masonbrink AR, Richardson T, Hall M, Catley D, Wilson K. Trends in Adolescent Cannabis-Related Hospitalizations by State Legalization Laws, 2008-2019. J Adolesc Health 2021; 69:999-1005. [PMID: 34511329 DOI: 10.1016/j.jadohealth.2021.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/06/2021] [Accepted: 07/21/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Adolescent cannabis use is associated with adverse health outcomes. The impact of cannabis legalization on adolescent cannabis-related hospitalizations remains unknown. We sought to assess whether state cannabis legalization is associated with adolescent cannabis-related hospitalizations. METHODS We conducted a retrospective cohort study of adolescent (11-17 years) hospitalizations at children's hospitals between January 1, 2008 and December 31, 2019 using the Inpatient Essentials database. We investigated differences in adolescent cannabis-related diagnosis during a hospitalization by state cannabis legalization status, including states with no legal use to medical cannabis laws (MCLs) and states with MCLs to nonmedical (>21 years old) cannabis laws (NMCLs). RESULTS Of 1,898,432 adolescent hospitalizations in 18 states and Washington, DC, there were 37,562 (2%) hospitalizations with a cannabis-related diagnosis, with 8,457 (23%) in states with no legal use, 20,444 (54%) in MCL states, and 8,661 (23%) in NMCL states. There was an increase in adjusted odds of a cannabis-related hospitalization in MCL (odds ratio 1.05, 95% confidence interval 1.04-1.06) and NMCL states (odds ratio 1.03, 95% confidence interval 1.02-1.03) between 2008 and 2019. Characteristics associated with the greatest increase in adjusted odds of a cannabis-related hospitalization postpolicy change included adolescents without an underlying mental health or other substance use disorder in MCL and NMCL states (p < .001) and younger age in NMCL states (13 vs. 16 and 17 years old, p = .02 and p = .02). CONCLUSIONS Cannabis-related adolescent hospitalizations at children's hospitals are increasing, with a disproportionate increase postlegalization in states with NMCLs. Interventions are warranted to increase cannabis use identification and treatment among at-risk adolescents in the hospital-based setting.
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Affiliation(s)
- Abbey R Masonbrink
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
| | - Troy Richardson
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Department of Pediatrics, Children's Hospital Association, Lenexa, Kansas
| | - Matt Hall
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Department of Pediatrics, Children's Hospital Association, Lenexa, Kansas
| | - Delwyn Catley
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Karen Wilson
- Department of Pediatrics, Mount Sinai Health System and Kravis Children's Hospital, New York, New York
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Leubitz A, Spiller HA, Jolliff H, Casavant M. Prevalence and Clinical Characteristics of Unintentional Ingestion of Marijuana in Children Younger Than 6 Years in States With and Without Legalized Marijuana Laws. Pediatr Emerg Care 2021; 37:e969-e973. [PMID: 34908380 DOI: 10.1097/pec.0000000000001841] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between state marijuana legalization and the rates of unintentional ingestions of marijuana in children younger than 6 years. METHODS This was a retrospective review of all marijuana ingestions in the National Poison Data System in children younger than 6 years between January 1, 2000, and July 31, 2017. Data analysis from NPDS included, age, sex, state and year of occurrence, clinical effects, therapies, health care facility utilization, and medical outcome. Population of children younger than 6 years was obtained from the US Census Bureau. Public records search provided state legal status of marijuana and year of state marijuana legalization. RESULTS From 2000 through 2008, there was no significant change in the annual number or rate of ingestions of marijuana in children younger than 6 years across the United States. Following 2009, there was mean annual increase of 27% per year, rising to 742 ingestions per year or 2.98 ingestions per 100,000 population, respectively, in 2017. More than 70% of all cases occurred in states with legalized marijuana. Of all pediatric patients, 54.6% received some form of hospital-based care, of which 7.5% required critical care. Pediatric patients experienced a wide range of symptoms from drowsiness and confusion, to seizures and coma. Medical treatments ranged from hydration therapy to sedation and intubation. Poison centers safely managed 23.4% of these pediatric cases by phone, without the need for hospital evaluation. CONCLUSION There was a strong association between the legalization of marijuana and ingestions of marijuana by children younger than 6 years.
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Affiliation(s)
- Andrew Leubitz
- From the Ohio University Heritage College of Osteopathic Medicine, Athens
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7
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Zuckermann AM, Gohari MR, Romano I, Leatherdale ST. Changes in cannabis use modes among Canadian youth across recreational cannabis legalization: Data from the COMPASS prospective cohort study. Addict Behav 2021; 122:107025. [PMID: 34175660 DOI: 10.1016/j.addbeh.2021.107025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 05/24/2021] [Accepted: 06/18/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Canadian youth consume cannabis in multiple ways, including by smoking, vaping, and eating or drinking. Existing evidence suggests that these behaviours may change after law liberalization, though data regarding youth are scarce. We investigated changes in cannabis modes of use and associated factors across the federal legalization of recreational cannabis use for adults in Canada, among a large sample of underage youth before alternative products were made legally available. METHODS Data were available from 2953 longitudinally linked Canadian high school students who reported on their cannabis use during the 2017/2018 and 2018/2019 school years. We explored whether students maintained a single or multiple cannabis use mode(s), contracted, or expanded the number of modes used. We then used generalized estimating equations to analyse associations of baseline characteristics with use mode trajectory. RESULTS Expansion of cannabis use modes (42.3%) was more common than maintenance of a single mode (31.3%), maintenance of multiple modes (14.3%), or reduction (12.1%). Students who maintained multiple modes were significantly more likely to have high amounts of weekly spending money (AOR 1.68), to binge drink (AOR 2.25) or vape (AOR 1.99), to use cannabis regularly (AOR 2.67), and to endorse more symptoms of depression (AOR 1.06). School support for quitting tobacco, drug, or alcohol use appeared to have no effect. CONCLUSIONS Multi-modal cannabis use increased among Canadian youth in our sample. Its association with other substance use and depressive symptoms may indicate clustering of additional harms. Screening for this use pattern may assist in identifying high-risk substance use and should be considered in the design of harm reduction programming.
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8
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Hall KE, Yang H, Goulding D, Contreras E, James KA. Interrupted time series analysis of cannabis coding in Colorado during the ICD-10-CM transition. Inj Prev 2021; 27:i66-i70. [PMID: 33674336 PMCID: PMC7948183 DOI: 10.1136/injuryprev-2019-043511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/03/2022]
Abstract
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), implemented in 2015, has more codes than ICD-9-CM for events involving cannabis. We examined cannabis indicator trends across the transition from ICD-9-CM to ICD-10-CM in Colorado, where state law regulates adult cannabis use. Using 2011 to 2018 data from hospital and emergency department (ED) discharges, we calculated monthly rates per 1000 discharges for two indicators: (1) cannabis use disorders and (2) poisoning and adverse effects of psychodysleptics. Immediate, point-of-transition (level) and gradual, post-transition (slope) changes across the ICD-9-CM to ICD-10-CM transition were tested using interrupted time series models adjusted for legalisation, seasonality and autocorrelation. We observed a level increase and slope increase in the rate of ED discharges with cannabis use disorders. Hospital discharges with cannabis use disorders had a negative slope change after the transition and no level change. ED discharges with poisoning and adverse effects of psychodysleptics showed an increase in slope after the transition. No effects of the transition were observed on hospital discharges with poisoning and adverse effects of psychodysleptics. Shifts in the level and slope of cannabis indicator rates after implementation of the new coding scheme suggest the use of caution when interpreting trends spanning the ICD-9-CM to ICD-10-CM transition.
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Affiliation(s)
- Katelyn E Hall
- Marijuana Health Monitoring Program, Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Hannah Yang
- EMS and Trauma Systems Section, Montana Department of Public Health and Human Services, Helena, Montana, USA
| | - DeLayna Goulding
- Marijuana Health Monitoring Program, Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Elyse Contreras
- Marijuana Health Monitoring Program, Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Katherine A James
- Colorado School of Public Health, University of Colorado Denver Graduate School, Aurora, Colorado, USA
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Takakuwa KM, Schears RM. The emergency department care of the cannabis and synthetic cannabinoid patient: a narrative review. Int J Emerg Med 2021; 14:10. [PMID: 33568074 PMCID: PMC7874647 DOI: 10.1186/s12245-021-00330-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cannabis is the most prevalent illegal drug used and the second most common cause of ED drug-related complaints in the USA. Recently, newer more potent strains, concentrated THC products, and consumption methods have become available. OBJECTIVE Our first objective was to define cannabis use in the USA and provide a summary background on its current preparations, pharmacokinetics, vital sign and physical exam findings, adverse effects, and laboratory testing. Our second objective, using the aforementioned summary as relevant background information, was to present and summarize the care and treatment of the most commonly reported cannabis-related topics relevant to ED physicians. METHODS We first performed an extensive literature search of peer-reviewed publications using New PubMed and Cochrane Central Register of Controlled Trials to identify the most commonly reported cannabis-related topics in emergency care. Once the six topic areas were identified, we undertook an extensive narrative literature review for each section of this paper using New PubMed and Cochrane Central Register of Controlled Trials from the inception of the databases to September 30, 2020. RESULTS The six subject areas that were most frequently reported in the medical literature relevant to cannabis-related ED care were acute intoxication/overdose, pediatric exposure, cannabinoid hyperemesis syndrome, cannabis withdrawal, e-cigarette or vaping product use-associated lung injury (EVALI), and synthetic cannabinoids. CONCLUSION As cannabis becomes more widely available with the adoption of state medical cannabis laws, ED-related cannabis visits will likely rise. While cannabis has historically been considered a relatively safe drug, increased legal and illegal access to newer formulations of higher potency products and consumption methods have altered the management and approach to ED patient care and forced physicians to become more vigilant about recognizing and treating some new cannabis-related life-threatening conditions.
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Affiliation(s)
- Kevin M Takakuwa
- Society of Cannabis Clinicians, PO Box 27574, San Francisco, CA, 94127, USA.
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Maclean JC, Ghimire KM, Nicholas LH. Marijuana legalization and disability claiming. HEALTH ECONOMICS 2021; 30:453-469. [PMID: 33166025 DOI: 10.1002/hec.4190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023]
Abstract
We study the effect of recent legalization of recreational marijuana use laws (RMLs) in the United States on new applications and allowances for Social Security Disability Insurance and Supplemental Security Income over the period 2001-2019. We combine administrative caseload data from the Social Security Administration with state policy changes using two-way fixed-effects methods. We find that RML adoption increases applications for both benefits. However, there is no change in allowances post-RML. We provide suggestive evidence that the observed changes in applications post-RML are driven by increases in marijuana misuse and selective migration, and decreases in unemployment.
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Affiliation(s)
- Johanna Catherine Maclean
- Department of Economics, Temple University, National Bureau of Economic Research, Research Affiliate, Institute of Labor Economics, Philadelphia, Pennsylvania, USA
| | - Keshar M Ghimire
- Business and Economics Department, University of Cincinnati, Blue Ash, Ohio, USA
| | - Lauren Hersch Nicholas
- Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Cannabis use, other drug use, and risk of subsequent acute care in primary care patients. Drug Alcohol Depend 2020; 216:108227. [PMID: 32911133 PMCID: PMC7896808 DOI: 10.1016/j.drugalcdep.2020.108227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/23/2020] [Accepted: 08/01/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cannabis and other drug use is associated with adverse health events, but little is known about the association of routine clinical screening for cannabis or other drug use and acute care utilization. This study evaluated whether self-reported frequency of cannabis or other drug use was associated with subsequent acute care. METHOD This retrospective cohort study used EHR and claims data from 8 sites in Washington State that implemented annual substance use screening. Eligible adult primary care patients (N = 47,447) completed screens for cannabis (N = 45,647) and/or other drug use, including illegal drug use and prescription medication misuse, (N = 45,255) from 3/3/15-10/1/2016. Separate single-item screens assessed frequency of past-year cannabis and other drug use: never, less than monthly, monthly, weekly, daily/almost daily. An indicator of acute care utilization measured any urgent care, emergency department visits, or hospitalizations ≤19 months after screening. Adjusted Cox proportional hazards models estimated risk of acute care. RESULTS Patients were predominantly non-Hispanic White. Those reporting cannabis use less than monthly (Hazard Ratio [HR] = 1.12, 95 % CI = 1.03-1.21) or daily (HR = 1.24; 1.10-1.39) had greater risk of acute care during follow-up than those reporting no use. Patients reporting other drug use less than monthly (HR = 1.34; 1.13-1.59), weekly (HR = 2.21; 1.46-3.35), or daily (HR = 2.53; 1.86-3.45) had greater risk of acute care than those reporting no other drug use. CONCLUSION Population-based screening for cannabis and other drug use in primary care may have utility for understanding risk of subsequent acute care. It is unclear whether findings will generalize to U.S. states with broader racial/ethnic diversity.
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Scheim AI, Maghsoudi N, Marshall Z, Churchill S, Ziegler C, Werb D. Impact evaluations of drug decriminalisation and legal regulation on drug use, health and social harms: a systematic review. BMJ Open 2020; 10:e035148. [PMID: 32958480 PMCID: PMC7507857 DOI: 10.1136/bmjopen-2019-035148] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To review the metrics and findings of studies evaluating effects of drug decriminalisation or legal regulation on drug availability, use or related health and social harms globally. DESIGN Systematic review with narrative synthesis. DATA SOURCES We searched MEDLINE, Embase, PsycINFO, Web of Science and six additional databases for publications from 1 January 1970 through 4 October 2018. INCLUSION CRITERIA Peer-reviewed articles or published abstracts in any language with quantitative data on drug availability, use or related health and social harms collected before and after implementation of de jure drug decriminalisation or legal regulation. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened titles, abstracts and articles for inclusion. Extraction and quality appraisal (modified Downs and Black checklist) were performed by one reviewer and checked by a second, with discrepancies resolved by a third. We coded study-level outcome measures into metric groupings and categorised the estimated direction of association between the legal change and outcomes of interest. RESULTS We screened 4860 titles and 221 full-texts and included 114 articles. Most (n=104, 91.2%) were from the USA, evaluated cannabis reform (n=109, 95.6%) and focussed on legal regulation (n=96, 84.2%). 224 study outcome measures were categorised into 32 metrics, most commonly prevalence (39.5% of studies), frequency (14.0%) or perceived harmfulness (10.5%) of use of the decriminalised or regulated drug; or use of tobacco, alcohol or other drugs (12.3%). Across all substance use metrics, legal reform was most often not associated with changes in use. CONCLUSIONS Studies evaluating drug decriminalisation and legal regulation are concentrated in the USA and on cannabis legalisation. Despite the range of outcomes potentially impacted by drug law reform, extant research is narrowly focussed, with a particular emphasis on the prevalence of use. Metrics in drug law reform evaluations require improved alignment with relevant health and social outcomes.
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Affiliation(s)
- Ayden I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Centre on Drug Policy Evaluation, St Michael's Hospital, Toronto, Ontario, Canada
| | - Nazlee Maghsoudi
- Centre on Drug Policy Evaluation, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Zack Marshall
- Social Work, McGill University, Montreal, Quebec, Canada
| | - Siobhan Churchill
- Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Carolyn Ziegler
- Library Services, Unity Health Toronto, Toronto, Ontario, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, St Michael's Hospital, Toronto, Ontario, Canada
- Medicine, University of California San Diego, La Jolla, California, USA
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Santaella-Tenorio J, Wheeler-Martin K, DiMaggio CJ, Castillo-Carniglia A, Keyes KM, Hasin D, Cerdá M. Association of Recreational Cannabis Laws in Colorado and Washington State With Changes in Traffic Fatalities, 2005-2017. JAMA Intern Med 2020; 180:1061-1068. [PMID: 32568378 PMCID: PMC7309574 DOI: 10.1001/jamainternmed.2020.1757] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE An important consequence of cannabis legalization is the potential increase in the number of cannabis-impaired drivers on roads, which may result in higher rates of traffic-related injuries and fatalities. To date, limited information about the effects of recreational cannabis laws (RCLs) on traffic fatalities is available. OBJECTIVE To estimate the extent to which the implementation of RCLs is associated with traffic fatalities in Colorado and Washington State. DESIGN, SETTING, AND PARTICIPANTS This ecological study used a synthetic control approach to examine the association between RCLs and changes in traffic fatalities in Colorado and Washington State in the post-RCL period (2014-2017). Traffic fatalities data were obtained from the Fatality Analysis Reporting System from January 1, 2005, to December 31, 2017. Data from Colorado and Washington State were compared with synthetic controls. Data were analyzed from January 1, 2005, to December 31, 2017. MAIN OUTCOME(S) AND MEASURES The primary outcome was the rate of traffic fatalities. Sensitivity analyses were performed (1) excluding neighboring states, (2) excluding states without medical cannabis laws (MCLs), and (3) using the enactment date of RCLs to define pre-RCL and post-RCL periods instead of the effective date. RESULTS Implementation of RCLs was associated with increases in traffic fatalities in Colorado but not in Washington State. The difference between Colorado and its synthetic control in the post-RCL period was 1.46 deaths per 1 billion vehicle miles traveled (VMT) per year (an estimated equivalent of 75 excess fatalities per year; probability = 0.047). The difference between Washington State and its synthetic control was 0.08 deaths per 1 billion VMT per year (probability = 0.674). Results were robust in most sensitivity analyses. The difference between Colorado and synthetic Colorado was 1.84 fatalities per 1 billion VMT per year (94 excess deaths per year; probability = 0.055) after excluding neighboring states and 2.16 fatalities per 1 billion VMT per year (111 excess deaths per year; probability = 0.063) after excluding states without MCLs. The effect was smaller when using the enactment date (24 excess deaths per year; probability = 0.116). CONCLUSIONS AND RELEVANCE This study found evidence of an increase in traffic fatalities after the implementation of RCLs in Colorado but not in Washington State. Differences in how RCLs were implemented (eg, density of recreational cannabis stores), out-of-state cannabis tourism, and local factors may explain the different results. These findings highlight the importance of RCLs as a factor that may increase traffic fatalities and call for the identification of policies and enforcement strategies that can help prevent unintended consequences of cannabis legalization.
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Affiliation(s)
- Julian Santaella-Tenorio
- Center for Opioid Epidemiology and Policy,Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York.,School of Basic Sciences, Universidad del Valle, Cali, Colombia
| | - Katherine Wheeler-Martin
- Center for Opioid Epidemiology and Policy,Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | - Charles J DiMaggio
- Center for Opioid Epidemiology and Policy,Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York.,Department of Surgery, New York University School of Medicine, New York, New York
| | - Alvaro Castillo-Carniglia
- Center for Opioid Epidemiology and Policy,Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York.,Society and Health Research Center and School of Public Health, Universidad Mayor, Santiago, Chile
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Deborah Hasin
- Division of Translational Epidemiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.,Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy,Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
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14
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Conyers G, Ayres I. A lottery test of the effect of dispensaries on emergency room visits in Arizona. HEALTH ECONOMICS 2020; 29:854-864. [PMID: 32548868 DOI: 10.1002/hec.4013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/02/2020] [Accepted: 02/10/2020] [Indexed: 06/11/2023]
Abstract
In August 2012, the Arizona Department of Health Services conducted a lottery to allocate licenses for the state's first medical marijuana dispensaries. The lottery randomly selected an applicant within each of 69 contested Community Health Analysis Areas to open a dispensary. By comparing 36 zip codes with winning applications to 48 zip codes with losing applications and weighting using propensity scores based on the true probability of winning, we estimate the causal effect of the allocation of a dispensary on the emergency room visits of residents of that zip code. Outcomes of interest are emergency room visits for acute symptoms caused by cannabis, opioids, alcohol, and cocaine. Using emergency room discharge data from 2010 to 2016, we find evidence of an increase in visits for acute cannabis-related causes for the winning set of zip codes and weak evidence of an increase in visits for opioid-related causes. The results indicate that in the four years following the lottery, emergency room visits for acute cannabis causes rose by approximately 45% in allocated zip codes relative to non-allocated zip codes. Because of the high likelihood of spillovers to neighboring zip codes, these effects are likely underestimates.
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Affiliation(s)
| | - Ian Ayres
- Yale Law School, Yale University, New Haven, Connecticut
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15
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Leveille CF, Issenman RM, Kam AJ. A case of cannabinoid hyperemesis syndrome highlighting related key paediatric issues. Paediatr Child Health 2020; 25:S7-S9. [PMID: 32581625 DOI: 10.1093/pch/pxaa029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/03/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Robert M Issenman
- Department of Pediatrics, McMaster University.,Division of Pediatric Gastroenterology, McMaster Children's Hospital
| | - April J Kam
- Department of Pediatrics, McMaster University.,Division of Pediatric Emergency Medicine, McMaster Children's Hospital
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16
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Venkatesan T, Hillard CJ, Rein L, Banerjee A, Lisdahl K. Patterns of Cannabis Use in Patients With Cyclic Vomiting Syndrome. Clin Gastroenterol Hepatol 2020; 18:1082-1090.e2. [PMID: 31352091 DOI: 10.1016/j.cgh.2019.07.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Some patients with cyclic vomiting syndrome (CVS) use cannabis to relieve stress and for its antiemetic properties. However, chronic cannabis use has been associated paradoxically with cannabinoid hyperemesis syndrome (CHS) and some patients with CVS are thought to have CHS. We sought to characterize patterns of cannabis use by patients with CVS and identify those who could be reclassified as having CHS. METHODS We performed a cross-sectional study of 140 patients with CVS (72% female; mean age, 37 ± 13 y) seen at a specialized clinic. Patients were screened for cannabis use with the cannabis use disorder identification test. Patients were classified as regular (use ≥4 times/wk) or occasional users (<4 times/wk). RESULTS Forty-one percent of patients were current cannabis users, with 21% reporting regular use. Regular users were more likely to be male and to report an anxiety diagnosis, and smoked cannabis with higher tetrahydrocannabinol content and for a longer duration. Most users reported that cannabis helped control CVS symptoms. Among all cannabis users, 50 of 57 (88%) reported that they had abstained for longer than 1 month, but only 1 user reported resolution of CVS episodes during the abstinence period. This patient subsequently resumed using cannabis but remains free of symptoms. CONCLUSIONS Cannabis is used commonly among patients with CVS-patients report relief of symptoms with use. We found 21% of patients with CVS to be regular users, but only 1 met the Rome IV criteria for CHS. Longitudinal studies are needed to determine the relationships among cannabis use, hyperemesis, and mood symptoms.
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Affiliation(s)
- Thangam Venkatesan
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Cecilia J Hillard
- Pharmacology and Toxicology, Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lisa Rein
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anjishnu Banerjee
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Krista Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
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17
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Abstract
Various states have legalized marijuana for medical purposes and/or decriminalized recreational marijuana use. These changes coincide with a decrease in perceived harmfulness of the drug and an increase in its use among youth. This change is of critical concern because of the potential harmful impact of marijuana exposure on adolescents. Marijuana use has been associated with several adverse mental health outcomes, including increased incidence of addiction and comorbid substance use, suicidality, and new-onset psychosis. Negative impacts on cognition and academic performance have also been observed. As the trend toward legalization continues, the pediatric community will be called on to navigate the subsequent challenges that arise with changing policies. Pediatricians are uniquely positioned to provide innovative care and educate youth and families on the ever-evolving issues pertaining to the impact of marijuana legalization on communities. In this article, we present and analyze the most up-to-date data on the effects of legalization on adolescent marijuana use, the effects of adolescent use on mental health and cognitive outcomes, and the current interventions being recommended for use in pediatric office settings.
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Affiliation(s)
- Kristie Ladegard
- Departments of Psychiatry and.,Department of Behavioral Health Services, Denver Health Medical Center, Denver, Colorado; and
| | - Christian Thurstone
- Departments of Psychiatry and.,Department of Behavioral Health Services, Denver Health Medical Center, Denver, Colorado; and
| | - Melanie Rylander
- Departments of Psychiatry and .,Department of Behavioral Health Services, Denver Health Medical Center, Denver, Colorado; and.,Internal Medicine, School of Medicine, University of Colorado, Aurora, Colorado
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18
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Hua JT, Afshar M, Clark BJ, Kovacs EJ, Burnham EL. The relationship of cannabis decriminalization in Colorado and cannabis use in individuals with alcohol use disorders. J Cannabis Res 2020; 2:13. [PMID: 33526125 PMCID: PMC7819320 DOI: 10.1186/s42238-020-00018-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/18/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Over the past decade, cannabis use has become increasingly popular in states that include Colorado. During this time, alcohol use disorders (AUDs) and alcohol-related medical conditions have also been consistently recognized as public health problems with increasing prevalence in the state. Despite the widespread use of cannabis in Colorado, the epidemiology of cannabis use among those with AUDs has been poorly described. Therefore, we sought to examine cannabis use among individuals with likely AUDs and individuals with low-risk alcohol use during a time of major Colorado legislative changes before and after legalization of recreational cannabis in 2012. METHODS This study was a secondary data analysis conducted with information from 303 participants (80% male) in the Denver, CO metropolitan enrolled between August 2007 and April 2016 for studies related to alcohol and lung health. Of these participants, 188 (62%) were completing inpatient alcohol detoxification with likely AUDs. All participants completed the Alcohol Use Disorder Identification Test (AUDIT) to establish their likelihood of an AUD, and all had information on current cannabis use assessed by questionnaire and urine toxicology testing. RESULTS Individuals with likely AUDs more commonly used cannabis compared to control participants (42% vs 27%, p = 0.007). In multiple logistic regression analyses, participant type (likely AUD versus control), tobacco smoking, and age were significantly associated with cannabis smoking; however, the year of participant enrollment was not. Adjusted odds for cannabis use among participants with likely AUDs were 2.97 (1.51-5.82), p = 0.002, while odds for cannabis use among tobacco smokers were 3.67 (1.94-6.93), p < 0.0001. Among control participants, tobacco smoking increased odds of cannabis use seven-fold. CONCLUSIONS Our findings highlight the exceptionally high odds of cannabis use among individuals with likely AUDs undergoing alcohol detoxification at a Colorado treatment facility before and after legalization of recreational cannabis. Targeted investigations into the medical and psychiatric consequences of combined alcohol and cannabis use are urgently needed to define its health impact in these vulnerable individuals.
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Affiliation(s)
- Jeremy T Hua
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Majid Afshar
- Department of Medicine, Division of Pulmonary and Critical Care, Loyola University Chicago Health Sciences Campus, Chicago, IL, USA
| | - Brendan J Clark
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, 12700 E. 19th St. C272, Aurora, CO, 80045, USA
| | - Elizabeth J Kovacs
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ellen L Burnham
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, 12700 E. 19th St. C272, Aurora, CO, 80045, USA.
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19
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Bhandari S, Jha P, Lisdahl KM, Hillard CJ, Venkatesan T. Recent trends in cyclic vomiting syndrome-associated hospitalisations with liberalisation of cannabis use in the state of Colorado. Intern Med J 2020; 49:649-655. [PMID: 30426628 DOI: 10.1111/imj.14164] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/25/2018] [Accepted: 11/08/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Currently, 33 states in the United States along with the District of Columbia have legalised cannabis in some forms. There is a paucity of data on the impact of legalisation of cannabis use on hospitalisations due to cyclic vomiting syndrome (CVS). AIM To study the trends in CVS-related hospitalisations and cannabis use in CVS in relation to legalisation of recreational cannabis use in Colorado. METHODS All hospital admissions in Colorado between 2010 and 2014 with the diagnosis of CVS were identified using the Colorado State Inpatient Database. Five-year trends in CVS-related hospitalisations along with the cannabis use were analysed. Multivariate logistic regression analysis was performed to determine predictors of cannabis use in CVS. RESULTS There was a significant increase in CVS-related hospitalisations by 46% from 806 in 2010 to 1180 in 2014 when CVS was included as all-listed diagnoses (P < 0.001). The overall prevalence of cannabis use in CVS (13% with CVS as primary diagnosis and 17% with CVS as all-listed diagnoses) was much higher than non-CVS-related hospitalisations (1.7%) (P < 0.001 for both comparisons). Cannabis use increased dramatically in both CVS and non-CVS-related hospitalisations following legalisation of cannabis for recreational use in 2012. CONCLUSION Our study shows a significant increase in CVS-related hospitalisations concomitant with an increase in cannabis use with its liberalisation in Colorado. Future studies on the relationship between cannabis use and hyperemesis are warranted, especially with its ongoing legalisation in the United States.
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Affiliation(s)
- Sanjay Bhandari
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pinky Jha
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Krista M Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Cecilia J Hillard
- Department of Pharmacology and Toxicology, and Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thangam Venkatesan
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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20
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Aydelotte JD, Mardock AL, Mancheski CA, Quamar SM, Teixeira PG, Brown CVR, Brown LH. Fatal crashes in the 5 years after recreational marijuana legalization in Colorado and Washington. ACCIDENT; ANALYSIS AND PREVENTION 2019; 132:105284. [PMID: 31518764 DOI: 10.1016/j.aap.2019.105284] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/15/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
Colorado and Washington legalized recreational marijuana in 2012, but the effects of legalization on motor vehicle crashes remains unknown. Using Fatality Analysis Reporting System data, we performed difference-in-differences (DD) analyses comparing changes in fatal crash rates in Washington, Colorado and nine control states with stable anti-marijuana laws or medical marijuana laws over the five years before and after recreational marijuana legalization. In separate analyses, we evaluated fatal crash rates before and after commercial marijuana dispensaries began operating in 2014. In the five years after legalization, fatal crash rates increased more in Colorado and Washington than would be expected had they continued to parallel crash rates in the control states (+1.2 crashes/billion vehicle miles traveled, CI: -0.6 to 2.1, p = 0.087), but not significantly so. The effect was more pronounced and statistically significant after the opening of commercial dispensaries (+1.8 crashes/billion vehicle miles traveled, CI: +0.4 to +3.7, p = 0.020). These data provide evidence of the need for policy strategies to mitigate increasing crash risks as more states legalize recreational marijuana.
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Affiliation(s)
- Jayson D Aydelotte
- Division of Acute Care Surgery, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas Austin, 1500 Red River St., Austin, TX 78701, USA
| | - Alexandra L Mardock
- UCLA David Geffen School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Christine A Mancheski
- Division of Emergency Medicine, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas Austin, 1400 N IH35, Suite 2.230, Austin, TX 78701, USA
| | - Shariq M Quamar
- University of Texas, c/o Division of Emergency Medicine, 1400 N IH35, Suite 2.230, Austin, TX 78701, USA
| | - Pedro G Teixeira
- Division of Acute Care Surgery, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas Austin, 1500 Red River St., Austin, TX 78701, USA
| | - Carlos V R Brown
- Division of Acute Care Surgery, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas Austin, 1500 Red River St., Austin, TX 78701, USA
| | - Lawrence H Brown
- Division of Emergency Medicine, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas Austin, 1400 N IH35, Suite 2.230, Austin, TX 78701, USA.
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21
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Heard K, Monte AA, Wang GS. Another Perspective on Cannabis and Emergency Medicine in Colorado. West J Emerg Med 2019; 20:855-856. [PMID: 31738711 PMCID: PMC6860395 DOI: 10.5811/westjem.2019.8.44882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kennon Heard
- University of Colorado School of Medicine, Department of Emergency Medicine, Section of Medical Pharmacology and Toxicology, Aurora, Colorado.,Rocky Mountain Poison and Drug Center, Denver, Colorado
| | - Andrew A Monte
- University of Colorado School of Medicine, Department of Emergency Medicine, Section of Medical Pharmacology and Toxicology, Aurora, Colorado.,Rocky Mountain Poison and Drug Center, Denver, Colorado
| | - George Sam Wang
- University of Colorado School of Medicine, Department of Emergency Medicine, Section of Medical Pharmacology and Toxicology, Aurora, Colorado.,Rocky Mountain Poison and Drug Center, Denver, Colorado.,University of Colorado School of Medicine, Department of Pediatrics, Section of Pediatric Emergency Medicine, Aurora, Colorado
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22
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Young SD, Padwa H, Bonar EE. Social Big Data as a Tool for Understanding and Predicting the Impact of Cannabis Legalization. Front Public Health 2019; 7:274. [PMID: 31637226 PMCID: PMC6787761 DOI: 10.3389/fpubh.2019.00274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/10/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sean D. Young
- University of California Institute for Prediction Technology, Department of Informatics, University of California, Irvine, Irvine, CA, United States
- Department of Emergency Medicine, University of California, Irvine, Irvine, CA, United States
| | - Howard Padwa
- Integrated Substance Abuse Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Erin E. Bonar
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, MI, United States
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23
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Shelton SK, Mills E, Saben JL, Devivo M, Williamson K, Abbott D, Hall KE, Monte AA. Why do patients come to the emergency department after using cannabis? Clin Toxicol (Phila) 2019; 58:453-459. [PMID: 31526057 DOI: 10.1080/15563650.2019.1657582] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Cannabis (MJ) policy liberalization in a majority of US states has impacted emergency department (ED) visits. It is important to understand why people come to the ED after using MJ because the drug is now available to experienced and naïve people across the country. The objectives of this study were to (1) improve upon administrative dataset methodology by performing additional chart review to describe ED visits related to cannabis, (2) understand why patients come to the ED after using cannabis, and (3) begin to inform our understanding of cannabis-attributable ED visits to start to educate patients and providers about cannabis' safety.Methods: We performed a retrospective chart review of ED visits identified by cannabis ICD-9 and 10-CM codes between 2012 and 2016. Visits were reviewed and determined if the visit was partially attributable to cannabis based upon a pre-specified definition, then categorized into clinical complaint categories. Descriptive statistics, Chi-Square, and T-tests were used to elucidate the data.Results: About one-fourth (25.74%) of visits with cannabis ICD-CM codes were found to be at least partially attributable to cannabis. These patients are more often young, Caucasian males when compared to the overall ED population (p < .0001). Patients with a cannabis-attributable visit were more often admitted to the hospital (p < .0001). The most common complaints in cannabis-attributable visits were gastrointestinal and psychiatric complaints, as well as intoxication. The number of cannabis-attributable visits rose with time (p=.012).Conclusions: Based on a pre-specified definition, with good inter-rater reliability, we found that 25% of visits with a cannabis ICD-CM code were partially attributable to cannabis. These findings represent areas to target in cannabis user education as public perceptions change across time.
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Affiliation(s)
- Shelby K Shelton
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Eleanor Mills
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jessica L Saben
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael Devivo
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kayla Williamson
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Diana Abbott
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Katelyn E Hall
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Andrew A Monte
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Rocky Mountain Poison & Drug Center, Denver, CO, USA.,Denver Health and Hospital Authority, Denver, CO, USA
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24
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Unhealthy Cannabis Use among Recreational and Medical Cannabis Users with Type 1 Diabetes. CANADIAN JOURNAL OF ADDICTION 2019. [DOI: 10.1097/cxa.0000000000000061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Wolf LA, Perhats C, Clark PR, Frankenberger WD, Moon MD. The perceived impact of legalized cannabis on nursing workload in adult and pediatric emergency department visits: A qualitative exploratory study. Public Health Nurs 2019; 37:5-15. [DOI: 10.1111/phn.12653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Lisa A. Wolf
- Institute for Emergency Nursing Research Emergency Nurses Association Schaumburg IL USA
| | - Cydne Perhats
- Institute for Emergency Nursing Research Emergency Nurses Association Schaumburg IL USA
| | - Paul R. Clark
- University of Louisville School of Nursing Louisville KY USA
- Norton Healthcare Institute for Nursing Louisville KY USA
| | - Warren D. Frankenberger
- Department of Nursing and Clinical Care Services Children’s Hospital of Philadelphia Philadelphia PA USA
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26
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Abstract
PURPOSE OF REVIEW To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population. RECENT FINDINGS There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts for an array of emergency department presentations of intentional or accidental cannabis use. The range of presentations documented in the recent literature spans gastrointestinal, psychiatric and cardiorespiratory effects, in addition to traumatic injuries and accidental ingestions by younger children. Complications of chronic cannabis use, such as 'cannabis hyperemesis syndrome', depression, psychosis or cognitive impairment, are now recognized outcomes and even more are likely to emerge. SUMMARY An array of cannabis-related symptoms is possible from acute use or exposure. Common presentations include acute intoxication, hyperemesis, depression and acute physical injuries from impaired psychomotor function. Uncommon presentations include cardiorespiratory effects, and a range of symptoms in young children that include hyperkinesis and coma. Clinical vigilance is needed to suspect and clinically diagnose cannabis exposure in the emergency department.
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27
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McConachie SM, Caputo RA, Wilhelm SM, Kale-Pradhan PB. Efficacy of Capsaicin for the Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review. Ann Pharmacother 2019; 53:1145-1152. [DOI: 10.1177/1060028019852601] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclic vomiting, abdominal pain, and alleviation of symptoms via hot showers in chronic cannabinoid users. Capsaicin is recommended as a reasonable first-line treatment approach for CHS despite limited clinical evidence regarding its use. The objective of this study is to systematically review the efficacy data for capsaicin in CHS. Data Sources: A literature search using keywords related to cannabinoids, emesis, and capsaicin was performed in MEDLINE, CINAHL, and EMBASE from inception through March 31, 2019. Study Selection and Data Extraction: Studies and published abstracts in which capsaicin was used for CHS and clinical outcomes were reported were eligible for inclusion. Data Synthesis: A total of 241 articles were screened, of which 5 full-text articles and 6 conference abstracts were included. Full-text case reports (n = 3) and case series (n = 2) found capsaicin to be effective in a total of 18 patients. Published abstracts were in the form of case reports (n = 1), case series (n = 3), and retrospective cohort studies (n = 2). Relevance to Patient Care and Clinical Practice: Capsaicin use was described as beneficial in all case series and case reports; however, both retrospective cohort studies were unable to find a significant benefit for capsaicin on primary outcomes (emergency department length of stay). Conclusion: Current data for capsaicin efficacy in CHS is of low methodological quality. However, the limited data on alternative antiemetic therapies and capsaicin’s favorable risk-benefit profile make it a reasonable adjunctive treatment option.
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Affiliation(s)
- Sean M. McConachie
- Wayne State University, Detroit, MI, USA
- Beaumont Hospital, Dearborn, MI, USA
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28
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Lane TJ, Hall W. Traffic fatalities within US states that have legalized recreational cannabis sales and their neighbours. Addiction 2019; 114:847-856. [PMID: 30719794 DOI: 10.1111/add.14536] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/26/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS A growing body of evidence suggests that cannabis impairs driving ability. We used mortality data to investigate whether the commercial sale of cannabis for recreational use affected traffic fatality rates both in states that legalized it and in neighbouring jurisdictions. DESIGN Interrupted time-series of traffic fatality rates adjusted for seasonality and autocorrelation. Changes are reported as step and trend effects against a comparator of states that had not implemented medicinal or recreational cannabis during the study period (2009-16). Sensitivity analyses added a 6-month 'phase-in' to account for lags in production. Meta-analyses were used to derive pooled results. SETTING Three states that legalized recreational cannabis sales [Colorado (January 2014), Washington State (June 2014) and Oregon (October 2015] and nine neighbouring jurisdictions [Kansas, Nebraska, New Mexico, Oklahoma and Utah (Colorado neighbours); British Columbia and Oregon (Washington neighbours); and California and Nevada (Oregon neighbours)]. MEASUREMENTS Monthly traffic fatalities rates per million residents using mortality data from CDC WONDER and RoadSafetyBC and census data. FINDINGS There was a pooled step increase of 1.08 traffic fatalities per million residents followed by a trend reduction of -0.06 per month (both P < 0.001), although with significant heterogeneity between sites (step: I2 = 73.7%, P < 0.001; trend: I2 = 68.4%; P = 0.001). Effects were similar in both legalizing (step: 0.90, P < 0.001; trend: -0.05, P = 0.007) and neighbouring sites (step: 1.15, P = 0.005; trend: -0.06, P = 0.001). The 6-month phase-in produced similar if larger effects (step: 1.36, P = 0.006; trend: -0.07, P < 0.001). CONCLUSIONS The combination of step increases and trend reductions suggests that in the year following implementation of recreational cannabis sales, traffic fatalities temporarily increased by an average of one additional traffic fatality per million residents in both legalizing US states of Colorado, Washington and Oregon and in their neighbouring jurisdictions.
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Affiliation(s)
- Tyler J Lane
- Insurance, Work and Health Group, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia.,National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Monte AA, Shelton SK, Mills E, Saben J, Hopkinson A, Sonn B, Devivo M, Chang T, Fox J, Brevik C, Williamson K, Abbott D. Acute Illness Associated With Cannabis Use, by Route of Exposure: An Observational Study. Ann Intern Med 2019; 170:531-537. [PMID: 30909297 PMCID: PMC6788289 DOI: 10.7326/m18-2809] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Little is known about the relative harms of edible and inhalable cannabis products. OBJECTIVE To describe and compare adult emergency department (ED) visits related to edible and inhaled cannabis exposure. DESIGN Chart review of ED visits between 1 January 2012 and 31 December 2016. SETTING A large urban academic hospital in Colorado. PARTICIPANTS Adults with ED visits with a cannabis-related International Classification of Diseases, Ninth or 10th Revision, Clinical Modification (ICD-9-CM or ICD-10-CM), code. MEASUREMENTS Patient demographic characteristics, route of exposure, dose, symptoms, length of stay, disposition, discharge diagnoses, and attribution of visit to cannabis. RESULTS There were 9973 visits with an ICD-9-CM or ICD-10-CM code for cannabis use. Of these, 2567 (25.7%) visits were at least partially attributable to cannabis, and 238 of those (9.3%) were related to edible cannabis. Visits attributable to inhaled cannabis were more likely to be for cannabinoid hyperemesis syndrome (18.0% vs. 8.4%), and visits attributable to edible cannabis were more likely to be due to acute psychiatric symptoms (18.0% vs. 10.9%), intoxication (48% vs. 28%), and cardiovascular symptoms (8.0% vs. 3.1%). Edible products accounted for 10.7% of cannabis-attributable visits between 2014 and 2016 but represented only 0.32% of total cannabis sales in Colorado (in kilograms of tetrahydrocannabinol) during that period. LIMITATION Retrospective study design, single academic center, self-reported exposure data, and limited availability of dose data. CONCLUSION Visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected. PRIMARY FUNDING SOURCE Colorado Department of Public Health and Environment.
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Affiliation(s)
- Andrew A Monte
- University of Colorado School of Medicine, Aurora, Colorado, and Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, Colorado (A.A.M.)
| | - Shelby K Shelton
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Eleanor Mills
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Jessica Saben
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Andrew Hopkinson
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Brandon Sonn
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Michael Devivo
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Tae Chang
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Jacob Fox
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Cody Brevik
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Kayla Williamson
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Diana Abbott
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
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Marx GE, Chen Y, Askenazi M, Albanese BA. Syndromic Surveillance of Emergency Department Visits for Acute Adverse Effects of Marijuana, Tri-County Health Department, Colorado, 2016-2017. Public Health Rep 2019; 134:132-140. [PMID: 30721641 PMCID: PMC6410484 DOI: 10.1177/0033354919826562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In Colorado, legalization of recreational marijuana in 2014 increased public access to marijuana and might also have led to an increase in emergency department (ED) visits. We examined the validity of using syndromic surveillance data to detect marijuana-associated ED visits by comparing the performance of surveillance queries with physician-reviewed medical records. METHODS We developed queries of combinations of marijuana-specific International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes or keywords. We applied these queries to ED visit data submitted through the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) syndromic surveillance system at 3 hospitals during 2016-2017. One physician reviewed the medical records of ED visits identified by ≥1 query and calculated the positive predictive value (PPV) of each query. We defined cases of acute adverse effects of marijuana (AAEM) as determined by the ED provider's clinical impression during the visit. RESULTS Of 44 942 total ED visits, ESSENCE queries detected 453 (1%) as potential AAEM cases; a review of 422 (93%) medical records identified 188 (45%) true AAEM cases. Queries using ICD-10 diagnostic codes or keywords in the triage note identified all true AAEM cases; PPV varied by hospital from 36% to 64%. Of the 188 true AAEM cases, 109 (58%) were among men and 178 (95%) reported intentional use of marijuana. Compared with noncases of AAEM, cases were significantly more likely to be among non-Colorado residents than among Colorado residents and were significantly more likely to report edible marijuana use rather than smoked marijuana use ( P < .001). CONCLUSIONS ICD-10 diagnostic codes and triage note keyword queries in ESSENCE, validated by medical record review, can be used to track ED visits for AAEM.
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Affiliation(s)
- Grace E. Marx
- Emergency Preparedness, Response, and Communicable Disease Surveillance, Tri-County Health Department, Greenwood Village, CO, USA
- Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yushiuan Chen
- Emergency Preparedness, Response, and Communicable Disease Surveillance, Tri-County Health Department, Greenwood Village, CO, USA
| | - Michele Askenazi
- Emergency Preparedness, Response, and Communicable Disease Surveillance, Tri-County Health Department, Greenwood Village, CO, USA
| | - Bernadette A. Albanese
- Emergency Preparedness, Response, and Communicable Disease Surveillance, Tri-County Health Department, Greenwood Village, CO, USA
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Heard K, Monte AA, Hoyte CO. Brief Commentary: Consequences of Marijuana-Observations From the Emergency Department. Ann Intern Med 2019; 170:124. [PMID: 30615784 PMCID: PMC6669097 DOI: 10.7326/m18-3280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Kennon Heard
- University of Colorado School of Medicine, Aurora, Colorado (K.H., A.A.M., C.O.H.)
| | - Andrew A Monte
- University of Colorado School of Medicine, Aurora, Colorado (K.H., A.A.M., C.O.H.)
| | - Christopher O Hoyte
- University of Colorado School of Medicine, Aurora, Colorado (K.H., A.A.M., C.O.H.)
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Davila VR, Stahl DL, Bhandary SP, Papadimos TJ. What's New in Critical Illness and Injury Science? The association between initial blood alcohol concentration and polysubstance use may be indicative of a gateway drug effect. Int J Crit Illn Inj Sci 2018; 8:181-183. [PMID: 30662862 PMCID: PMC6311969 DOI: 10.4103/ijciis.ijciis_80_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Victor R. Davila
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David L. Stahl
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sujatha P. Bhandary
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas J. Papadimos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Simons-Linares CR, Barkin JA, Wang Y, Jaiswal P, Trick W, Bartel MJ, Barkin JS. Is There an Effect of Cannabis Consumption on Acute Pancreatitis? Dig Dis Sci 2018; 63:2786-2791. [PMID: 29922897 DOI: 10.1007/s10620-018-5169-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 06/12/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Twenty-percentage of acute pancreatitis (AP) cases is labeled as idiopathic. Cannabis remains the most frequently used illicit drug in the world. The aim of this study was to identify the prevalence of cannabis use among all patients with a first episode of AP, particularly in those labeled as idiopathic etiology, and determine any effect on AP severity. METHODS Retrospective cohort of all consecutive patients admitted with a first episode of AP at a large tertiary referral hospital from 01/2013 through 12/2014. AP was identified by ICD9 code, or lipase ≥ 3 times the upper limit of normal and abdominal pain consistent with AP. Cannabis users (CU) were identified via history or urine toxicology. RESULTS Four hundred and sixty patients were included. 54% were men, with a mean age of 48 years (range 17-89 years). Forty-eight patients (10%) were identified as CU. After adjusting for admission SIRS, age, and gender, cannabis use was not found to be an independent risk factor for persistent SIRS, AKI, ARDS, pancreatic necrosis, mortality, ICU admission, length of stay, in-hospital infections, nor recurrent AP. Of note, AKI was least common among non-CU compared to CU (OR 0.4; p = 0.02; CI 0.2-0.9) and non-CU had a higher admission BISAP score (≥ 2) compared to CU (OR 2.5; p = 0.009; CI 1.2-4.9). CONCLUSION This is the largest study to date examining cannabis use in AP. Cannabis use was found across almost all etiologies of AP with a prevalence of 10% (48 cases), and in 9% (9 cases) of so-called idiopathic AP cases in this cohort, which could account as an association for approximately 2% of all AP cases. Cannabis use did not independently impact AP severity or mortality.
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Affiliation(s)
- C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Jodie A Barkin
- Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Yuchen Wang
- John Stroger Hospital of Cook County, Chicago, IL, USA
| | | | - William Trick
- John Stroger Hospital of Cook County, Chicago, IL, USA
| | - Michael J Bartel
- Section of Gastroenterology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | - Jamie S Barkin
- Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
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Davidson M, Reed S, Oosthuizen J, O’Donnell G, Gaur P, Cross M, Dennis G. Occupational health and safety in cannabis production: an Australian perspective. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2018; 24:75-85. [PMID: 30281413 PMCID: PMC6237171 DOI: 10.1080/10773525.2018.1517234] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/25/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022]
Abstract
The legal Australian cannabis industry has been rapidly expanding due to increased awareness of the plant's therapeutic potential, as well its diverse range of applications including biofuel, textiles, building materials, food, nutritional supplement, and animal feed. The objective of this paper is to describe the current landscape of the commercial Australian cannabis industry, summarise occupational health and safety (OHS) hazards in cannabis-related working environments, and provide suggestions for safeguarding worker health and well-being in this emerging industry. A comprehensive search of peer-reviewed and grey literature published between 1900 and 2017 was undertaken to identify case studies and original epidemiological research on OHS hazards associated with the cannabis cultivation and the manufacture of cannabis-based products. The review found that the majority of OHS studies were undertaken in the hemp textile industry during the late twentieth century, with a small number of articles published from a variety of occupational environments including forensic laboratories and recreational marijuana farms. Cannabis harvesting and initial processing is labour intensive, and presents a physical hazard Depending on the operation, workers may also be exposed to a variety of biological, chemical, and physical hazards including: organic dusts, bioaerosols, pollen/allergens, volatile organic compounds, psychoactive substances (tetrahydrocannabinol [THC])), noise, and ultraviolet radiation. Little research has been undertaken on the exposure to inhalable organic dust and other bioaerosols during the commercial cultivation and manufacture of cannabis-based products. Furthermore, there is an absence of Australian-based research and OHS guidance materials to help professionals develop risk management strategies in this evolving industry. It is recommended that: Investigation into the toxicological properties of cannabis dusts, specifically in relation to potential occupational exposures during cultivation and manufacture, should be a priority. The interim adoption of the respirable cotton dust exposure standard of 0.2 mg/m3 for workplace exposure in hemp facilities until a cannabis workplace exposure standard is developed, and that exposure to medicinal cannabis containing THC are kept as low as reasonably practicable. An industry partnership be established for the development of an Australian health and safety guideline for the production of medicinal cannabis and hemp. A classification to meet the requirements of the Global Harmonization Scheme should be undertaken to ensure consistency in the use of safety and risk phrases in cannabis-related industries.
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Affiliation(s)
- Maggie Davidson
- School of Science and Health, Western Sydney University, Sydney, Australia
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Sue Reed
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Jacques Oosthuizen
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Greg O’Donnell
- Test Safe Analytical Services, Safe Work NSW, Sydney, Australia
| | - Pragna Gaur
- Illicit Drugs Analysis Unit, Forensics Analytical Science Services, Sydney, Australia
| | - Martyn Cross
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Gary Dennis
- School of Science and Health, Western Sydney University, Sydney, Australia
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Zhu H, Wu LT. Sex Differences in Cannabis Use Disorder Diagnosis Involved Hospitalizations in the United States. J Addict Med 2018; 11:357-367. [PMID: 28700366 PMCID: PMC5636049 DOI: 10.1097/adm.0000000000000330] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 06/02/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study examined sex differences in trend and clinical characteristics of cannabis use disorder (CUD) diagnosis involved hospitalizations among adult patients. METHODS We analyzed hospitalization data from the 2007-2011 Nationwide Inpatient Samples for patients aged 18-64 years (N = 15,114,930). Descriptive statistics were used to characterize demographic variables and to compare the proportions of CUD diagnosis and comorbid patterns between male and female hospitalizations. Logistic regressions were performed to examine the association of sex and other demographic variables with CUD diagnosis. RESULTS During the study period, 3.3% of male and 1.5% of female hospitalizations had any-listed CUD diagnoses, and both sexes presented an upward trend in the number, rate, and proportion of CUD diagnosis. Among hospitalizations for patients aged 18-25 years, about 1 in 10 males and 1 in 20 females included a CUD diagnosis, and this proportion decreased with age strata. Mental disorders accounted for the highest proportion of CUD involved inpatient hospitalizations, and female CUD involved hospitalizations included a higher proportion of mental disorders that required hospitalized care compared with male hospitalizations (41% vs 36%). In each sex group, younger age, black race, lower household income, large metropolitan residence, non-private insurance, substance use diagnosis, and mental disorders were associated with elevated odds of having CUD diagnosis. CONCLUSION The large sample of clinical hospitalization data suggest an increased trend in CUD diagnosis and sex differences in several comorbidities with CUD-involved hospital admissions. Prevention and treatment for CUD should consider sex differences in clinical comorbidities.
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Affiliation(s)
- He Zhu
- Department of Psychiatry and Behavioral Sciences (HZ, L-TW); Duke University Medical Center, Department of Medicine, Division of General Internal Medicine, Duke University Medical Center (L-TW); Duke Clinical Research Institute (L-TW); and Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC (L-TW)
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Hall KE, Monte AA, Chang T, Fox J, Brevik C, Vigil DI, Van Dyke M, James KA. Mental Health-related Emergency Department Visits Associated With Cannabis in Colorado. Acad Emerg Med 2018; 25:526-537. [PMID: 29476688 DOI: 10.1111/acem.13393] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/05/2018] [Accepted: 02/17/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cannabis legalization in Colorado resulted in increased cannabis-associated health care utilization. Our objective was to examine cooccurrence of cannabis and mental health diagnostic coding in Colorado emergency department (ED) discharges and replicate the study in a subpopulation of ED visits where cannabis involvement and psychiatric diagnosis were confirmed through medical review. METHODS We collected statewide ED International Classification of Diseases, 9th Revision, Clinical Modification diagnoses from the Colorado Hospital Association and a subpopulation of ED visits from a large, academic hospital from 2012 to 2014. Diagnosis codes identified visits associated with mental health and cannabis. Codes for mental health conditions and cannabis were confirmed by manual records review in the academic hospital subpopulation. Prevalence ratios (PRs) of mental health ED discharges were calculated to compare cannabis-associated visits to those without cannabis. Rates of mental health and cannabis-associated ED discharges were examined over time. RESULTS Statewide data demonstrated a fivefold higher prevalence of mental health diagnoses in cannabis-associated ED visits (PR = 5.35, 95% confidence interval [CI], 5.27-5.43) compared to visits without cannabis. The hospital subpopulation supported this finding with a fourfold higher prevalence of psychiatric complaints in cannabis attributable ED visits (PR = 4.87, 95% CI = 4.36-5.44) compared to visits not attributable to cannabis. Statewide rates of ED visits associated with both cannabis and mental health significantly increased from 2012 to 2014 from 224.5 to 268.4 per 100,000 (p < 0.0001). CONCLUSIONS In Colorado, the prevalence of mental health conditions in ED visits with cannabis-associated diagnostic codes is higher than in those without cannabis. There is a need for further research determining if these findings are truly attributed to cannabis or merely coincident with concurrent increased use and availability.
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Affiliation(s)
- Katelyn E. Hall
- Department of Environmental Epidemiology Occupational Health, and Toxicology Colorado Department of Public Health and Environment Denver CO
| | - Andrew A. Monte
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
- Rocky Mountain Poison & Drug Center Denver Health and Hospital Authority Denver CO
| | - Tae Chang
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Jacob Fox
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Cody Brevik
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Daniel I. Vigil
- Department of Environmental Epidemiology Occupational Health, and Toxicology Colorado Department of Public Health and Environment Denver CO
| | - Mike Van Dyke
- Department of Environmental Epidemiology Occupational Health, and Toxicology Colorado Department of Public Health and Environment Denver CO
| | - Katherine A. James
- Department of Family Medicine University of Colorado School of Medicine Aurora CO
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Wang GS, Hall K, Vigil D, Banerji S, Monte A, VanDyke M. Marijuana and acute health care contacts in Colorado. Prev Med 2017; 104:24-30. [PMID: 28365373 PMCID: PMC5623152 DOI: 10.1016/j.ypmed.2017.03.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/20/2017] [Accepted: 03/27/2017] [Indexed: 12/14/2022]
Abstract
Over 22 million Americans are current users of marijuana; half of US states allow medical marijuana, and several allow recreational marijuana. The objective of this study was to evaluate the impact marijuana has on hospitalizations, emergency department (ED) visits, and regional poison center (RPC) calls in Colorado, a medical and recreational marijuana state. This is a retrospective review using Colorado Hospital Association hospitalizations and ED visits with marijuana-related billing codes, and RPC marijuana exposure calls. Legalization of marijuana in Colorado has been associated with an increase in hospitalizations, ED visits, and RPC calls linked with marijuana exposure. From 2000 to 2015, hospitalization rates with marijuana-related billing codes increased from 274 to 593 per 100,000 hospitalizations in 2015. Overall, the prevalence of mental illness among ED visits with marijuana-related codes was five-fold higher (5.07, 95% CI: 5.0, 5.1) than the prevalence of mental illness without marijuana-related codes. RPC calls remained constant from 2000 through 2009. However, in 2010, after local medical marijuana policy liberalization, the number of marijuana exposure calls significantly increased from 42 to 93; in 2014, after recreational legalization, calls significantly increased by 79.7%, from 123 to 221 (p<0.0001). The age group <17years old also had an increase in calls after 2014. As more states legalize marijuana, it is important to address public education and youth prevention, and understand the impact on mental health disorders. Improvements in data collection and surveillance methods are needed to more accurately evaluate the public health impact of marijuana legalization.
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Affiliation(s)
- George Sam Wang
- Section of Emergency Medicine, Medical Toxicology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Rocky Mountain Poison and Drug Center, Denver Health Hospital, Denver, CO, United States.
| | - Katelyn Hall
- Colorado Department of Public Health and Environment, Denver, CO, United States
| | - Daniel Vigil
- Colorado Department of Public Health and Environment, Denver, CO, United States
| | - Shireen Banerji
- Rocky Mountain Poison and Drug Center, Denver Health Hospital, Denver, CO, United States; University of Colorado School of Pharmacy, Anschutz Campus, Aurora, CO, United States
| | - Andrew Monte
- Section of Emergency Medicine, Medical Toxicology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Rocky Mountain Poison and Drug Center, Denver Health Hospital, Denver, CO, United States; University of Colorado School of Pharmacy, Anschutz Campus, Aurora, CO, United States; Department of Emergency Medicine, Medical Toxicology, University of Colorado Hospital, University of Colorado Anschutz Medical Campus, United States
| | - Mike VanDyke
- Colorado Department of Public Health and Environment, Denver, CO, United States
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Ghosh TS, Vigil DI, Maffey A, Tolliver R, Van Dyke M, Kattari L, Krug H, Reed JK, Wolk L. Lessons learned after three years of legalized, recreational marijuana: The Colorado experience. Prev Med 2017; 104:4-6. [PMID: 28232101 DOI: 10.1016/j.ypmed.2017.02.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/16/2017] [Accepted: 02/18/2017] [Indexed: 11/24/2022]
Abstract
In November 2012 Colorado voters approved legalized recreational marijuana. On January 1, 2014 Colorado became the first state to allow legal sales of non-medical marijuana for adults over the age of 21. Since that time, the state has been monitoring potential impacts on population health. In this paper we present lessons learned in the first three years following legal sales of recreational marijuana. These lessons pertain to health behaviors and health outcomes, as well as to health policy issues. Our intent is to share these lessons with other states as they face the prospect of recreational marijuana legalization.
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Affiliation(s)
- Tista S Ghosh
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States; Colorado Department of Public Health and Environment, Laboratory Services Division, 8100 Lowry Boulevard, Denver, CO 80230, United States.
| | - Daniel I Vigil
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Ali Maffey
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Rickey Tolliver
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Mike Van Dyke
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Leonardo Kattari
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Heather Krug
- Colorado Department of Public Health and Environment, Laboratory Services Division, 8100 Lowry Boulevard, Denver, CO 80230, United States.
| | - Jack K Reed
- Colorado Department of Public Safety, Division of Criminal Justice, 700 Kipling Street, Suite 1000, Lakewood, CO 80215, United States.
| | - Larry Wolk
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States; Colorado Department of Public Health and Environment, Laboratory Services Division, 8100 Lowry Boulevard, Denver, CO 80230, United States.
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Abstract
OBJECTIVES To examine trends and correlates of cannabis-involved emergency department (ED) visits in the United States from 2004 to 2011. METHODS Data were obtained from the 2004 to 2011 Drug Abuse Warning Network. We analyzed trend in cannabis-involved ED visits for persons aged ≥12 years and stratified by type of cannabis involvement (cannabis-only, cannabis-polydrug). We used logistic regressions to determine correlates of cannabis-involved hospitalization versus cannabis-involved ED visits only. RESULTS Between 2004 and 2011, the ED visit rate increased from 51 to 73 visits per 100,000 population aged ≥12 years for cannabis-only use (P value for trend = 0.004) and from 63 to 100 for cannabis-polydrug use (P value for trend < 0.001). Adolescents aged 12-17 years showed the largest increase in the cannabis-only-involved ED visit rate (rate difference = 80 per 100,000 adolescents). Across racial/ethnic groups, the most prevalent ED visits were noted among non-Hispanic blacks. Among cannabis-involved visits, the odds of hospitalization (vs ED visits only) increased with age strata compared with age 12 to 17 years. CONCLUSIONS These findings suggest a notable increase in the ED visit numbers and rates for both the use of cannabis-only and cannabis-polydrug during the studied period, particularly among young people and non-Hispanic blacks.
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Sokoya M, Eagles J, Okland T, Coughlin D, Dauber H, Greenlee C, Winkler AA. Patterns of facial trauma before and after legalization of marijuana in Denver, Colorado: A joint study between two Denver hospitals. Am J Emerg Med 2017; 36:780-783. [PMID: 29031478 DOI: 10.1016/j.ajem.2017.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/26/2017] [Accepted: 10/06/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The effect of marijuana on human health has been studied extensively. Marijuana intoxication has been shown to affect performance, attention span, and reaction time. The public health relationship between trauma and cannabis use has also been studied, with mixed conclusions. In this report, the effect of marijuana legalization on many aspects of facial trauma at two hospitals in Denver, Colorado is examined. METHODS A retrospective review of the electronic medical records was undertaken. Mann-Whitney U tests were used to compare age of patients before and after legalization, and chi squared analyses were used to compare mechanism of injury, and fracture types before and after recreational marijuana legalization in Denver, Colorado. Geographical location of patients was also considered. RESULTS No significant increase was found in race before and after marijuana legalization (p=0.19). A significant increase in age was found before (M=39.54,SD=16.37), and after (M=41.38,SD=16.66) legalization (p<0.01). Maxillary and skull base fracture proportions significantly increased following legalization (p<0.001 and p<0.001respectively). No significant differences were seen in the proportion of patients who lived in urban and rural counties before and after legalization (p>0.05). CONCLUSION Public health efforts should be directed towards educating residents and visitors of Colorado on the effects and toxicology of marijuana. More epidemiologic studies are needed for further assessment of the long-term effects of the legalization of marijuana on the population.
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Affiliation(s)
- Mofiyinfolu Sokoya
- University of Colorado School of Medicine Department of Otolaryngology, United States.
| | - Justin Eagles
- University of Colorado School of Medicine, United States
| | - Tyler Okland
- University of Colorado School of Medicine, United States
| | - Dylan Coughlin
- University of Colorado School of Medicine, United States
| | - Hannah Dauber
- University of Colorado School of Medicine Department of Otolaryngology, United States
| | - Christopher Greenlee
- University of Colorado School of Medicine Department of Otolaryngology, United States
| | - Andrew A Winkler
- University of Colorado School of Medicine Department of Otolaryngology, United States
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Heard K, Marlin MB, Nappe T, Hoyte CO. Common marijuana-related cases encountered in the emergency department. Am J Health Syst Pharm 2017; 74:1904-1908. [PMID: 28947626 DOI: 10.2146/ajhp160715] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kennon Heard
- University of Colorado School of Medicine, Denver, CO
| | | | - Thomas Nappe
- Rocky Mountain Poison and Drug Center, Denver, CO
| | - Christopher O Hoyte
- University of Colorado School of Medicine, Denver, CO.,Rocky Mountain Poison and Drug Center, Denver, CO
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Pergam SA, Woodfield MC, Lee CM, Cheng G, Baker KK, Marquis SR, Fann JR. Cannabis use among patients at a comprehensive cancer center in a state with legalized medicinal and recreational use. Cancer 2017; 123:4488-4497. [PMID: 28944449 PMCID: PMC5698756 DOI: 10.1002/cncr.30879] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/26/2017] [Accepted: 06/05/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cannabis is purported to alleviate symptoms related to cancer treatment, although the patterns of use among cancer patients are not well known. This study was designed to determine the prevalence and methods of use among cancer patients, the perceived benefits, and the sources of information in a state with legalized cannabis. METHODS A cross‐sectional, anonymous survey of adult cancer patients was performed at a National Cancer Institute–designated cancer center in Washington State. Random urine samples for tetrahydrocannabinol provided survey validation. RESULTS Nine hundred twenty‐six of 2737 eligible patients (34%) completed the survey, and the median age was 58 years (interquartile range [IQR], 46‐66 years). Most had a strong interest in learning about cannabis during treatment (6 on a 1‐10 scale; IQR, 3‐10) and wanted information from cancer providers (677 of 911 [74%]). Previous use was common (607 of 926 [66%]); 24% (222 of 926) used cannabis in the last year, and 21% (192 of 926) used cannabis in the last month. Random urine samples found similar percentages of users who reported weekly use (27 of 193 [14%] vs 164 of 926 [18%]). Active users inhaled (153 of 220 [70%]) or consumed edibles (154 of 220 [70%]); 89 (40%) used both modalities. Cannabis was used primarily for physical (165 of 219 [75%]) and neuropsychiatric symptoms (139 of 219 [63%]). Legalization significantly increased the likelihood of use in more than half of the respondents. CONCLUSIONS This study of cancer patients in a state with legalized cannabis found high rates of active use across broad subgroups, and legalization was reported to be important in patients' decision to use. Cancer patients desire but are not receiving information about cannabis use during their treatment from oncology providers. Cancer 2017;123:4488‐97. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. Cannabis use is common among patients receiving treatment at a large cancer center in a state with legalized recreational and medical cannabis. Active use is reported across broad demographic and diagnostic cancer subgroups, and legalization is reported to be important in patients' decision to use.
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Affiliation(s)
- Steven A. Pergam
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWashington
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashington
- Department of MedicineUniversity of WashingtonSeattleWashington
- Infection PreventionSeattle Cancer Care AllianceSeattleWashington
| | - Maresa C. Woodfield
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWashington
| | - Christine M. Lee
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWashington
- Center for the Study of Health and Risk BehaviorsUniversity of WashingtonSeattleWashington
| | - Guang‐Shing Cheng
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashington
- Department of MedicineUniversity of WashingtonSeattleWashington
| | - Kelsey K. Baker
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashington
| | - Sara R. Marquis
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWashington
| | - Jesse R. Fann
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashington
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWashington
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Wu LT, Zhu H, Mannelli P, Swartz MS. Prevalence and correlates of treatment utilization among adults with cannabis use disorder in the United States. Drug Alcohol Depend 2017; 177:153-162. [PMID: 28599214 PMCID: PMC5538354 DOI: 10.1016/j.drugalcdep.2017.03.037] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The increase in cannabis potency may have treatment implications for cannabis use disorder (CUD). Given the reported increase in prevalence of cannabis use among adults, there is a need to understand substance use treatment needs for CUD. METHODS We examined demographics and behavioral health indicators of adults aged ≥18 years that met criteria for past-year CUD (n=10,943) in the 2005-2013 National Surveys on Drug Use and Health. We determined prevalence and correlates of past-year treatment use for alcohol/drug, any drug, and cannabis use related problems, to inform treatment efforts for CUD. RESULTS The majority of adults with past-year CUD were young adults aged 18-25 or men, had low income, and did not attend college. Two-thirds of adults with CUD met criteria for cannabis dependence, which was comparatively common among younger adults, women, low-income or publicly insured adults, and college-educated adults. Nicotine dependence (40.92%) and alcohol (44.07%) or other drug use disorder (19.70%) were prevalent among adults with CUD. Overall, less than 13% of adults with CUD had received alcohol/drug use treatment the past year; only 7.8% received cannabis-specific treatment. There was no significant yearly variation in treatment use prevalence over 9 years. In particular, Asian-Americans, women, and college-educated adults underutilized cannabis-specific treatment. CONCLUSIONS This large sample of adults with CUD reveals pervasive underutilization of cannabis-related treatment, especially in women, married adults, and those with college education, despite a high proportion of comorbid behavioral health problems.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
| | - He Zhu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham,NC, USA
| | - Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham,NC, USA
| | - Marvin S. Swartz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham,NC, USA
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Aydelotte JD, Brown LH, Luftman KM, Mardock AL, Teixeira PGR, Coopwood B, Brown CVR. Crash Fatality Rates After Recreational Marijuana Legalization in Washington and Colorado. Am J Public Health 2017. [PMID: 28640679 DOI: 10.2105/ajph.2017.303848] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate motor vehicle crash fatality rates in the first 2 states with recreational marijuana legalization and compare them with motor vehicle crash fatality rates in similar states without recreational marijuana legalization. METHODS We used the US Fatality Analysis Reporting System to determine the annual numbers of motor vehicle crash fatalities between 2009 and 2015 in Washington, Colorado, and 8 control states. We compared year-over-year changes in motor vehicle crash fatality rates (per billion vehicle miles traveled) before and after recreational marijuana legalization with a difference-in-differences approach that controlled for underlying time trends and state-specific population, economic, and traffic characteristics. RESULTS Pre-recreational marijuana legalization annual changes in motor vehicle crash fatality rates for Washington and Colorado were similar to those for the control states. Post-recreational marijuana legalization changes in motor vehicle crash fatality rates for Washington and Colorado also did not significantly differ from those for the control states (adjusted difference-in-differences coefficient = +0.2 fatalities/billion vehicle miles traveled; 95% confidence interval = -0.4, +0.9). CONCLUSIONS Three years after recreational marijuana legalization, changes in motor vehicle crash fatality rates for Washington and Colorado were not statistically different from those in similar states without recreational marijuana legalization. Future studies over a longer time remain warranted.
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Affiliation(s)
- Jayson D Aydelotte
- Jayson D. Aydelotte, Kevin M. Luftman, Pedro G. R. Teixeira, Ben Coopwood, and Carlos V. R. Brown are with Trauma Service, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Lawrence H. Brown is with the Emergency Medicine Residency Program, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Alexandra L. Mardock is with Rice University, Houston, TX
| | - Lawrence H Brown
- Jayson D. Aydelotte, Kevin M. Luftman, Pedro G. R. Teixeira, Ben Coopwood, and Carlos V. R. Brown are with Trauma Service, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Lawrence H. Brown is with the Emergency Medicine Residency Program, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Alexandra L. Mardock is with Rice University, Houston, TX
| | - Kevin M Luftman
- Jayson D. Aydelotte, Kevin M. Luftman, Pedro G. R. Teixeira, Ben Coopwood, and Carlos V. R. Brown are with Trauma Service, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Lawrence H. Brown is with the Emergency Medicine Residency Program, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Alexandra L. Mardock is with Rice University, Houston, TX
| | - Alexandra L Mardock
- Jayson D. Aydelotte, Kevin M. Luftman, Pedro G. R. Teixeira, Ben Coopwood, and Carlos V. R. Brown are with Trauma Service, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Lawrence H. Brown is with the Emergency Medicine Residency Program, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Alexandra L. Mardock is with Rice University, Houston, TX
| | - Pedro G R Teixeira
- Jayson D. Aydelotte, Kevin M. Luftman, Pedro G. R. Teixeira, Ben Coopwood, and Carlos V. R. Brown are with Trauma Service, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Lawrence H. Brown is with the Emergency Medicine Residency Program, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Alexandra L. Mardock is with Rice University, Houston, TX
| | - Ben Coopwood
- Jayson D. Aydelotte, Kevin M. Luftman, Pedro G. R. Teixeira, Ben Coopwood, and Carlos V. R. Brown are with Trauma Service, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Lawrence H. Brown is with the Emergency Medicine Residency Program, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Alexandra L. Mardock is with Rice University, Houston, TX
| | - Carlos V R Brown
- Jayson D. Aydelotte, Kevin M. Luftman, Pedro G. R. Teixeira, Ben Coopwood, and Carlos V. R. Brown are with Trauma Service, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Lawrence H. Brown is with the Emergency Medicine Residency Program, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas-Austin. Alexandra L. Mardock is with Rice University, Houston, TX
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Rylander M, Winston HR, Medlin H, Hull M, Nussbaum A. The association of cannabis use on inpatient psychiatric hospital outcomes. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:73-84. [PMID: 28613973 DOI: 10.1080/00952990.2017.1329313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The associations between cannabis use and psychosis are well documented in numerous studies. There is a need to evaluate the impact of cannabis use on inpatient psychiatric utilization and outcomes. OBJECTIVES To evaluate the impact of cannabis use on psychiatric hospital outcomes. METHODS This study was conducted between April 20, 2015 and October 20, 2015. All patients (n = 120) admitted to Denver Health with psychotic symptoms were administered a urine toxicology screening testing for the presence of 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH, the active metabolite of cannabis). Patients with positive tests were compared to those with negative tests on several measures, including length of stay, presence or lack of 30-day readmission, Brief Psychotic Rating Scale (BPRS) score, and use of antipsychotics and/or sedatives/anxiolytics. RESULTS There were 120 patients. Twenty nine were women and 91 were men. Patients testing positive for THC-COOH had a shorter length of stay compared to patients testing negative for THC-COOH, after adjusting for age, prior psychiatric admissions, history of a psychotic-spectrum disorder, and comorbid additional substance use (p = 0.02). There were no differences in 30-day readmissions, 30-day post-discharge presentation to the Denver Health psychiatric emergency department, BPRS scores, and medication administration. CONCLUSION Patients presenting with psychotic symptoms and cannabis use require shorter inpatient psychiatric hospitalizations. This study is the first to quantify this observation and highlights the need for future clinical decision-making tools that would ideally correlate cannabis use with the degree of potential need for expensive and scarce mental health resources, such as psychiatric hospitalization.
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Affiliation(s)
- Melanie Rylander
- a University of Colorado School of Medicine , Department of Psychiatry, Denver Health Medical Center , Denver , CO , USA
| | - Helena R Winston
- b Department of Psychiatry , University of Colorado School of Medicine , Denver , CO , USA
| | - Haley Medlin
- a University of Colorado School of Medicine , Department of Psychiatry, Denver Health Medical Center , Denver , CO , USA
| | - Madelyne Hull
- c Department of Internal Medicine , Denver Health Medical Center , Denver , CO , USA
| | - Abraham Nussbaum
- a University of Colorado School of Medicine , Department of Psychiatry, Denver Health Medical Center , Denver , CO , USA.,d Denver Health Medical Center , Denver , CO , USA
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46
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Subbaraman MS, Kerr WC. Support for marijuana legalization in the US state of Washington has continued to increase through 2016. Drug Alcohol Depend 2017; 175:205-209. [PMID: 28448904 PMCID: PMC5509359 DOI: 10.1016/j.drugalcdep.2017.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/16/2017] [Accepted: 02/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Support for the legalization of recreational marijuana continues to increase across the United States and globally. In 2016, recreational marijuana was legalized in the most populous US state of California, as well as three other states. The primary aim of this study was to examine trends in support for recreational marijuana legalization in Washington, a state which has had legal recreational marijuana for almost four years, using data collected over the four years post-legalization. A secondary aim was to examine trends in support for the cultivation of marijuana for personal use. METHODS Data come from geographically representative general population samples of adult (aged 18 and over) Washington residents collected over five timepoints (every six months) between January 2014 and April 2016 (N=4101). Random Digit Dial was used for recruitment. Statistical analyses involved bivariate comparisons of proportions across timepoints and subgroups (defined by age, gender, and marijuana user status), and multivariable logistic regression controlling for timepoint (time) to formally test for trend while controlling for demographic and substance use covariates. All analyses adjusted for probability of selection. RESULTS Support for legalization in Washington has significantly increased: support was 64.0% (95% CI: 61.2%-67.8%) at timepoint 1 and 77.9% (95% CI: 73.2%-81.9%) at timepoint 5. With each six months' passing, support increased 19% on average. We found no statistically significant change in support for home-growing. CONCLUSIONS Support for marijuana legalization has continued to significantly increase in a state that has experienced the policy change for almost four years.
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Affiliation(s)
| | - William C. Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, CA
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Mdege ND, Meader N, Lloyd C, Parrott S, McCambridge J. The Novel Psychoactive Substances in the UK Project: empirical and conceptual review work to produce research recommendations. PUBLIC HEALTH RESEARCH 2017. [DOI: 10.3310/phr05040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundAlthough illegal drug use has largely been declining in the UK over the past decade, this period has witnessed the emergence of a range of novel psychoactive substances (NPS) (‘legal highs’). These are new, mostly synthetic, substances that mimic the effects of existing drugs). Despite there being many causes for concern in relation to NPS, there has been little prior study of the burden associated with their use in public health terms. Clarity is lacking on research priorities in this rapidly developing literature.ObjectivesTo inform the development of public health intervention research on NPS by reviewing existing data on their use, associated problems and potential responses to such problems.DesignA scoping review and narrative synthesis of selected bodies of evidence was undertaken to summarise and evaluate what is known about NPS use and the related harms of, and responses to, such use. Relevant literature was identified from electronic databases (covering January 2006 to June 2016 inclusive), Google (Google Inc., Mountain View, CA, USA), relevant websites and online drug forums and by contacting experts. Articles were included if they were primary studies, secondary studies involving the analysis and interpretation of primary research or discussion papers. A conceptual framework postulating an evidence-informed public health approach to NPS use in the UK was developed through a pragmatic literature review, the iterative development of concepts and finalisation in light of the results from the empirical review work. The process also involved feedback from various stakeholders. Research recommendations were developed from both strands of work.ResultsA total of 995 articles were included in the scoping review, the majority of which related to individual-level health-related adverse effects attributable to NPS use. The prevalence of lifetime NPS use varied widely between (e.g. with higher prevalence in young males) and within population subgroups. The most commonly reported adverse effects were psychiatric/other neurological, cardiovascular, renal and gastrointestinal manifestations, and there is limited evidence available on responses. In these and other respects, available evidence is at an early stage of development. Initial evidence challenges the view that NPS should be treated differently from other illicit drugs. The conceptual framework indicated that much of the evidence that would be useful to inform public health responses does not yet exist. We propose a systems-based prevention approach that develops existing responses, is multilevel and life course informed in character, and emphasises commonalities between NPS and other legal and illegal drug use. We make 20 recommendations for research, including nine key recommendations.LimitationsScoping reviews do not interrogate evidence in depth, and the disjunction between the scoping review and the conceptual framework findings is worthy of careful attention.ConclusionsKey research recommendations build on those that have previously been made and offer more evidence-based justification and detail, as previous recommendations have not yet been acted on. The case for decision-making on commissioning new research based on these recommendations is both strong and urgent.Future workThe validity of recommendations generated through this project could be enhanced via further work with research commissioners, policy-makers, researchers and the public.Study registrationThe systematic review element of this study is registered as PROSPERO CRD42016026415.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Noreen D Mdege
- Department of Health Sciences, University of York, York, UK
| | - Nick Meader
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Charlie Lloyd
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
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Barrus DG, Capogrossi KL, Cates SC, Gourdet CK, Peiper NC, Novak SP, Lefever TW, Wiley JL. Tasty THC: Promises and Challenges of Cannabis Edibles. METHODS REPORT (RTI PRESS) 2016; 2016. [PMID: 28127591 DOI: 10.3768/rtipress.2016.op.0035.1611] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Food products containing cannabis extract (edibles) have emerged as a popular and lucrative facet of the legalized market for both recreational and medicinal cannabis. The many formulations of cannabis extracts used in edibles present a unique regulatory challenge for policy makers. Though edibles are often considered a safe, discreet, and effective means of attaining the therapeutic and/or intoxicating effects of cannabis without exposure to the potentially harmful risks of cannabis smoking, little research has evaluated how ingestion differs from other methods of cannabis administration in terms of therapeutic efficacy, subjective effects, and safety. The most prominent difference between ingestion and inhalation of cannabis extracts is the delayed onset of drug effect with ingestion. Consumers often do not understand this aspect of edible use and may consume a greater than intended amount of drug before the drug has taken effect, often resulting in profoundly adverse effects. Written for the educated layperson and for policy makers, this paper explores the current state of research regarding edibles, highlighting the promises and challenges that edibles present to both users and policy makers, and describes the approaches that four states in which recreational cannabis use is legal have taken regarding regulating edibles.
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Bhandari S, Hillard CJ, Venkatesan T. Marijuana users do not have increased healthcare utilization: A National Health and Nutrition Examination Survey (NHANES) study. Eur J Intern Med 2016; 34:e9-e10. [PMID: 27499177 DOI: 10.1016/j.ejim.2016.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 11/22/2022]
Affiliation(s)
- Sanjay Bhandari
- Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Cecilia J Hillard
- Neuroscience Research Center, and Department of Pharmacology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Thangam Venkatesan
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA.
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50
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Wang GS. Food for thought. Clin Toxicol (Phila) 2016; 54:817-818. [PMID: 27534572 DOI: 10.1080/15563650.2016.1214279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- George Sam Wang
- a University of Colorado Anschutz Medical Campus, Children's Hospital Colorado , Aurora , CO , USA
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